Medical Sensor Kit for Combination with a Chair to Enable Measurement of Diagnostic Information

ABSTRACT

A medical examination chair kit includes a group of sensors including electrodes in finger-tip sensors, various other types of sensors incorporated in covers attachable or placeable on a chair and load cells on an adjustable grid supporting the chair, all of which provide data which is partially processed in a transmission pocket mounted on the chair.

CROSS REFERENCE TO RELATED APPLICATIONS

This is a continuation application of the following applications whichare incorporated herein by reference and for which priority is claimed:(1) application Ser. No. 13/540,276, filed Jul. 2, 2012 entitled“Medical Sensor Kit for Combination with a Chair to Enable Measurementof Diagnostic Information” (2) application Ser. No. 12/724,141 filedMar. 15, 2010 (now U.S. Pat. No. 8,235,895) which claims the benefit ofSer. No. 61/160,135 filed Mar. 13, 2009 entitled “Medical Sensor Kit forCombination with a Chair to Enable Measurement of DiagnosticInformation” and is a continuation of application Ser. No. 10/890,042and application Ser. No. 10/276,455 (3) continuation application Ser.No. 13/092,570 filed Apr. 22, 2011 (now U.S. Pat. No. 8,211,014) whichis a continuation of Ser. No. 10/890,042 filed Jul. 13, 2004 entitled“Chair and Ancillary Apparatus with Medical Diagnostic Features in aRemote Health Monitoring System”, which is a continuation of utilityapplication Ser. No. 10/276,455 filed Nov. 18, 2002 (now U.S. Pat. No.6,832,987) entitled “Chair and Ancillary Apparatus with MedicalDiagnostic Features in a Remote Health Monitoring System” which is basedon PCT/US01/16360 filed May 18, 2001, which is a utility applicationbased upon and incorporating by reference the following threeprovisional applications: Ser. No. 60/232,708 filed Sep. 15, 2000entitled “Chair and Ancillary Apparatus with Medical Diagnostic Featuresin a Remote Health Monitoring System”, Ser. No. 60/205,369 filed May 18,2000 entitled “Chair and Ancillary Apparatus with Medical DiagnosticFeatures”, and Ser. No. 60/205,144 filed May 18, 2000 “Hand GripMonitoring Device”, upon which we claim priority.

BACKGROUND OF THE INVENTION

In a principal aspect, the present invention relates to a kit that maybe mounted or incorporated with a chair for use in the conduct ofmedical diagnostic tests in a diagnostic system wherein the subject maybe remotely located from a control center.

U.S. Pat. No. 5,544,649, incorporated herewith by reference, disclosesvarious techniques for interactive patient monitoring from a centralstation, (e.g., a clinic) of patients located at a remote site, (e.g.,their home). The diagnostic techniques disclosed in U.S. Pat. No.5,544,649 rely, at least in part, upon utilization of apparatus, such asa diagnostic chair incorporating various sensor apparatus to facilitatethe conduct of diagnostic measurements. U.S. Pat. No. 5,544,649discloses a chair which includes sensors for measuring patienttemperature, blood pressure and the like, and for transmitting such datavia alternative transmission means to a central station for analysis anddiagnosis.

The diagnostic session involving a patient in a remote location chairmay be interactive. That is, the health care professional at the centralstation and the patient at the remote site are in real time, two-wayaudio and video communication and diagnostic data sensed at the remotelocation is simultaneously provided in real time to the central station.Such communication enhances the validity and the scope of the diagnostictests being conducted.

The diagnostic information is analyzed by personnel at the centralstation. This provides a convenient and low cost manner in which tomonitor patient condition without requiring the patient to physicallytravel to a diagnostic clinic or hospital. This technique and theassociated apparatus also enable the health practitioner to direct thepatient through test protocols and to diversify or revise the testprotocols as necessary during the interactive session.

The use of apparatus of this type disclosed, and, in particular, a chairand various other ancillary equipment have become the topic of continuedresearch and development in order to provide apparatus which senses thediagnostic parameters necessary to provide immediate and appropriatepatient health care or monitoring in an inexpensive, yet highly reliablemanner. Such continued research and development has led to the discoveryof the apparatus disclosed in U.S. Pat. No. 6,832,987 issued Dec. 21,2004 for a Chair and Ancillary Apparatus with Medical Diagnosticfeatures in a Remote Health Monitoring System and also provides for thecombination of such apparatus in an interactive diagnostic system U.S.Pat. No. 6,832,937 is incorporated herewith by reference.

The cost and care of a chair and associated apparatus may inhibit thepractical adoption of the technology taught in the aforesaid references.Thus, there has developed a need to develop more usable, cost effectivesystems for remote monitoring of diagnostic health parameters orinformation.

SUMMARY OF THE INVENTION

Briefly, the present invention relates to the construction and design ofa diagnostic sensor kit for use in combination with a chair or othersupport platform device used for subject monitoring and medicalexamination and to the combination of such a device with a system forremote monitoring from a central station.

The device in the form of a kit incorporates numerous apparatus for theacquisition of physiological and other diagnostic parameters from asubject who is sitting in a chair to which the kit has been attached. Ina preferred embodiment, a conventional chair is utilized in combinationwith a kit which accepts commands for the acquisition and analysis ofdiagnostic data and sends the results, either processed on site and/oras raw data, by wireless communication to a relay system located at thesite. The relay system then transfers data received from instrumentationincorporated in the kit to a central system by means of a wide bandwidthpublic channel (e.g., wireless network, telephone system, cable modem orother public utility). Communication and sensor control is interactive.That is, the transmissions are two-way transmissions. Additionally,other communication channels are simultaneously operative, e.g., audioand video are interactive. Simultaneous, two-way transmission on threechannels results in the capacity to diagnose and, to a limited extent,treat a patient at a remote site interactively. The channels may also beintegrated for example by modulation or packing of a single channelsignal.

By way of example and not limitation, the following medical informationand testing, protocols are enabled by the kit design: (1) finger-tipECG, (2) “safety-belt” diagnostic ECG, (3) non-invasive blood pressure,(4) weight, (5) balance, (6) respiration rate, (7) saturated pulseoximetry (Sp02), (8) blood glucose analysis, (9) lung sounds, (10)expiratory flow (respiration exhale and/or inhale flow rates), (11) skinresistance, and (12) hand grip strength. All of the instrumentationrequired for the various measurements recited are an integral part ofthe kit. No special knowledge, expertise, or physical dexterity isrequired on the part of the patient or subject to participate in thetest procedures since all of the instruments are an integral part of thekit which is easily attached to a conventional chair. The chair providesan ergonomically safe support for the patient, an aesthetically pleasantappearance and the kit includes storage for the sensors and instrumentsnot in use.

Exemplary of the diagnostic capabilities of the system is measurement ofhand grip strength of a patient. That is, a hand grip instrument candetect whether the patient suffers from tremors when gripping an objectand thus can be relied upon as a diagnostic tool to evaluate the healthof a patient. Apparatus which provide information of this general naturealso allows assessment of motor activity which is associated withneurological features or capacity of a patient as well as strength whichis associated with the muscle characteristics of a patient. Suchmonitoring is capable of projecting the likelihood or impact of stroke,for example, and other patient abnormalities.

Thus, a hand grip monitoring device which, in one embodiment, includes abladder in the form of an elongated ellipsoid may be provided. A sourceof pressurized fluid is provided to the bladder with a check valveconnected to the bladder filled with a predetermined volume of fluid(e.g., gas or liquid). A sensor is connected to the bladder formonitoring the fluid pressure in the bladder and providing a firstsignal which represents the absolute pressure therein and a secondsignal representative of the change in pressure over time. A recordermay be provided for recording the first and second signals. Dataassociated with the first and second signals is analyzed, the firstsignal being representative of the total energy associated with patientgrip and the second signal associated with tremors or a change inpressure with time. As indicated heretofore, tremors may be indicativeof neurological status, neuromuscular pathology or stroke. The systemmay include historical recordings of like signals or a library of datato compare with the measurement or sensed signals in order to determinethe change in patient health with time. Alarms may be provided to alertthe medical technician at the central station of deviation beyond thegeneral patient specific norm.

Another example involves load cells incorporated on a grid structurethat is mounted to the support legs of a chair. The cells detect shiftsin weight which, in turn, can be relied upon to diagnose balance andother physiological characteristics of a patient.

The chair and its associated diagnostic sensors may be utilized incombination with a remote monitoring system or infrastructure whichoperates from a central station by communication techniques withmultiple, remote sites.

It is an object of the invention to provide a diagnostic kit forattachment to or combination with a chair and other ancillary apparatusused in combination with the chair to provide sensors that reliablyinteract with a patient for the measurement of respiration rate,pulmonary condition, heart condition, muscle strength, blood pressure,and other physiological parameters.

Yet a further object of the invention is to provide a highly reliable,yet inexpensive diagnostic apparatus comprised of a kit which is compactand which may be combined with a chair at a remote location yet easilytransported from one location to another and easily interfaced withanother chair and sensor transmission equipment and with a remotediagnostic system of the type generally depicted in U.S. Pat. No.5,544,649.

Another object of the invention is to provide a kit for a chair whichmaybe utilized to obtain diagnostic data from subjects located at aremote site for transmission to and recordal at a central station inorder to obtain an historic record of the subject indicative of thewellness or deterioration in wellness of the subject or the status ofrecovery of the subject.

These and other objects, advantages and features of the invention willbe set forth in the detailed description which follows.

BRIEF DESCRIPTION OF THE DRAWING

In the detailed description which follows, reference will be made to thedrawing comprised of the following figures:

FIG. 1 is a side elevation of an embodiment of a chair with integratedsensing apparatus;

FIG. 1 a is an exploded sectional view of a portion of the chairdepicted in FIG. 1;

FIG. 2 is a front elevation of the chair of FIG. 1;

FIG. 3 is a schematic view of a hand grip sensor utilized in combinationwith a chair or with a kit for a chair;

FIG. 4 is a diagrammatic view of a diagnostic chair having integratedsensors or a kit incorporated in a remote monitoring system;

FIG. 5 is a block diagram of the signal processing protocol for the loadcells associated with measurement of weight, balance, respiration rateand other physical characteristics of a subject;

FIG. 6 is a series of graphs depicting the readings from load cells on atime scale and further depicting readings which represent the sum ofvarious combinations of signals;

FIG. 7 is a series of graphs similar to FIG. 6 representing a distinctphysiological pattern;

FIG. 8 is another series of graphs similar to FIG. 6 representing afurther distinct physiological pattern; and

FIG. 9 is another series of graphs similar to FIG. 6 representing afurther distinct physiological pattern or event;

FIG. 10 is a photograph of a typical chair in combination with a sensorkit for measurement of diagnostic information;

FIG. 11 is a photograph of the chair of FIG. 10 depicting the oppositeside of the chair and the attached sensor kit; and

FIG. 12 is a photograph of the adjustable grid for the load cellspositioned under the four legs of the chair of FIG. 10.

DETAILED DESCRIPTION OF EMBODIMENTS

The apparatus of the invention comprises the combination of a chair orequivalent patient support platform such as a bed, gurney or the likewith various data, audio and visual transmission components. Thus, thechair depicted in FIGS. 1 and 2, involves data sensing, collection andtransmission, as well as control of sensors in the chair through thedata transmission links or channels. The chair typically comprises anelement of an overall system and has self-contained sensing and controlelements. FIG. 4 illustrates the chair and home unit components of sucha system and the invention is described in the embodiment of a chairthough other platform devices may be substituted such as a bed.

FIGS. 4-9 relate to the sensor operation and examples of the informationwhich the system may gather for the purpose of diagnosis. FIGS. 10-12relate to a kit comprised of various sensors and diagnostic componentswhich may be incorporated with a multitude of chair designs therebyenabling use of a typical chair in combination with a diagnostic kit andthus avoiding the cost of using a special chair for diagnostic purposes.

Referring to FIGS. 1-9, an exemplary chair with integrated sensorsincludes the following elements: a seat 14, a back support 16 and anoptional moveable, cantilever leg support 18. The chair is mounted onfour, spaced legs 20 or equivalent four mounting pads on the bottom of achair base. Each leg 20 or mounting pad is supported on a separate loadcell 22. A stable platform 23 supports the four load cells 22. The loadcells 22 on fixed support platform 23 are used to measure or indicateweight, balance, and weight distribution at any given time and as afunction of time as described in more detail below. The load cells 22preferably are positioned on the corners of a rectangle.

Back support 16 includes an array of straps 24, 26, 28 and anon-invasive blood pressure cuff strap 33. Strap 26 is an electronicstethoscope strap 26 used for assessment of heart and lung sounds andincludes a respirometer used for measuring respiration data. A “safetybelt” like strap 28 is used for diagnostic ECG (electrocardiogram). The“safety belt” like strap 28 is similar to the design of a safety beltused in an automobile with attached electrodes 29 to permit secureplacement of the electrodes 29 in the appropriate position on a humansubject for obtaining a diagnostic single, multiple or full 12 lead ECGmeasurement. Ancillary 29 may be provided on the other straps 24, 26.

Moveable, cantilever leg support 18 facilitates raising the legs of apatient from resting on the floor when measuring patient weight by loadcells 22. A strain gage 19 in leg support 18 also allows measurement ofleg muscle strength. That is, a patient may attempt to lower the support18 by engagement with their legs. The force imparted on support 18 bysuch activity may be sensed by a strain gage 19 to thereby provide ameasurement of leg strength, muscle condition and muscle coordination.

Arm rests or supports 30 include “finger-tip” electrodes 32, 34 used formeasuring a single lead ECG lead-I and skin resistance. A hand-grip 36is used to measure hand muscular strength and control. A skin sensor 38is used to measure blood glucose measurements. An infra-red emitter andsensor 40 is used to measure SpO2. An infra-red (IR) transmitter andreceiver 42 is used for wireless communication to a transmission device44 located at the patient or remote site. Communication device 44 isthen linked to a central station, for example, by a wirelesstransmission, switched network cable line, telecommunication line or thelike. An electronics enclosure 50 is attached underneath the seat 14 andcontains the analog to digital conversion and microprocessor electronicsfor the operation of the sensor instruments in the chair.

The chair is designed so that the entire weight of the person sitting inthe chair is transferred solely to the load cells 22. Thus, rectangularplatform or frame 23 holds four load cells 22 arranged at the corners ofthe rectangular platform 23 supporting the chair. The frame 23 providesa means for physically locating the load cells 22 for supporting thechair. The frame 23 allows the load cells 22 to be fixed in each of thefour corners of the rectangle or in any other desired geometric patternassociated with the legs 20 or chair support and the diagnosticprotocol. Electronics which provide a common reference voltage to allload cells 22; differential amplifiers which amplify the temporalchanges due to the weight shift on each load cell 22; bandpass filterfor respiratory monitoring; low pass filter for human balance monitoringand a microprocessor with a multi-channel analog to digital converterare all housed in the enclosure 50. Software which controls datacollection and signal processing is also incorporated in the hardware inthe enclosure 50. Though the four load cells 22 are in a rectangulararray, additional load cells in other arrays may be utilized to measureweight distribution as it varies with time over the surface of the seat14 to thereby permit diagnostic measurements of the type discussedhereinafter. Each of the cells 22 provide a separate, recordable signalto the processing equipment described for ultimate transmission to acentral station.

Respiration Rate Measurement

As previously described, a recliner chair is preferably used in orderthat support 18 will lift the feet of the patient from the floor. Thisis done so that all of the body weight of the patient is supportedsolely by the chair and the weight is directed in some pattern ofdistribution to each of the four sensors or load cells 22 under thechair seat 14 during measurement of respiration and other indices ofpatient health. That is, as a patient breathes, there is a small shiftof weight from the back to the front of the chair or vice versa. Thisweight shift is transferred to the appropriate front and back load cells22 in response to the shifting of patient weight due to respiration. Theload cells 22 are thus arranged such that they can detect small changesin load due to patient respiratory induced weight shift. In other words,the load cells 22 are arranged so that they can detect load changes inboth the X and Y directions, i.e., side to side and front to back ofseat 14. As schematically depicted in FIG. 5, a high pass filter may beused to remove the DC component of the weight signal allowing only theAC changes in the signal to be passed. Since the AC changes are verysmall compared with the DC component, AC coupling allows the signal tobe highly amplified. The signal to noise response of the system isimproved by the quadrature nature of the signals. The quadrature natureof the signals arises from the fact that any increase in weight in onedirection in the X-Y plane is compensated by an equal decrease in weightin the opposing direction in the X-Y plane. Noise and non-body movementartifacts thus can be removed from the signal. The front to back andside to side signal change of a sitting or recumbent subject representsrespiration rate and many other physical parameters. In other words, byappropriately positioning load cells 22 and processing the AC componentassociated with changes in weight distribution, the system enables aphysician or diagnostician located at a remote site to monitorrespiration rate of the patient in real time responsive, for example, toinstructed as well as natural breathing patterns. For example, thepatient may have exercised before sitting in the diagnostic chairthereby enabling the diagnostician the opportunity to evaluaterespiration rate following activity as well as at rest. Many variablepatterns of patient activity are possible, all of which may be remotelymonitored using the described system.

Weight

The lower portion of the chair acts as a scale that allows measurementof the gross weight of the patient sitting in the seat 14 of the chair.To measure total weight, the patient must raise his or her feet from thefloor allowing all of the body weight to fall on the seat 14 of thechair. The DC component of the load cells signal is indicative ofweight. Note, the chair may not include the cantilever leg support 18 inwhich event the patient must lift his or her legs from the floor toprovide a true DC weight signal by the load cells 22. Also if theplatform is a bed on gurney, then positioning of cells 22 will bedependent on the size of the platform and the platform will normally besupportive of leg or limb weight.

Balance

Each individual who sits down in the chair or gets up from the chairproduces a characteristic response signature of time dependent weightdistribution on each of the four load cells 22. The signature is usedfor historical reference to determine if changes in this signature mayindicate physiological or pathological trauma as suggested, for example,by a change in patient ability to balance and in the response time tothe command to change position (e.g., to rise from the chair) followinginstructions.

The monitoring of balance is accomplished by recording, for example, thetransient response on the load cells 22 as a patient rises from thechair. The transient response provides a characteristic picturesignature of the shifts of body weight as a function of time when thepatient rises. For example, the weight is initially transferred from theback to the front of the chair and then later to the arms 30 whichprovide support for the person rising from the chair. Information fromthe four load cells 22 over time provides a characteristic picturesignature of temporal balance changes as one rises from the chair. Anexample of data provided for diagnostic analysis includes measurement ofthe movement of the center of mass of a patient over seat 14 in the Xand Y directions as a function of time. Unlike respiration, the weightsignals relating to changes in balance and gross weight are largesignals containing the DC element. The system is designed so that thecharacteristic frequency of the load cells 22 is well above the upperfrequency response required from the system.

Periodic monitoring of a person rising from the chair produces datapattern signatures. These patterns are stored and statistically comparedto new data using multidimensional statistical analysis. When the newdata pattern signature is significantly different than the stored datapattern, an alarm (not shown) may be activated indicating the need forfurther diagnostic investigation. That alarm may be in the chair, butmore appropriately is maintained at the diagnostic center.

In summary, the load cells 22 generate a myriad of data, includingweight or load change as a function of time for each cell 22 as well asgross load for each cell 22 as a function of time. Preferably, this datais collected in its most basic form as analog signals by sensors 22. Thesignals are then typically converted to digital form by the software andhardware in the chair and transmitted by a wireless transmitter 42 to areceiver 44 at the remote site. There receiver 44 may store the data,compress the data and otherwise preliminarily process the data andsubsequently forward the data via a preferred network, for example, tothe central station. The data transmission may be interspersed with dataor control signals to the transmitter 44. The data may thus bedownloaded periodically or continually and may be processed, in partbefore transmission or transmitted in full.

The load cell 22 signals may be assigned to a single channel fortransmission to the central station separate from the other diagnosticsignals so that the interrelationship of the various diagnosticprotocols may be observed. For example, weight shift data and grossweight data may interrelate with heart rate data to provide diagnosticinsight. Consequently, assigning weight or load cell information to onedata channel and heart rate and condition to another data channel may beoptionally desired and programmed. Other diagnostic information may alsobe simultaneously recorded or sensed and then correlated with heart,weight distribution data, etc. Of course simultaneous audio and videointeraction may also occur to facilitate the diagnostic activity.

FIGS. 6 through 9 are graphical results derived from load cellmeasurements of the direct current (weight parameter) of the load cells22 in an experiment conducted to evaluate the diagnostic capacity of thedevice. The load cells were placed in a rectangular array with left andright back sensors or load cells 22 attached to the back legs or backedge of the chair and left and right sensors or load cells 22 attachedto with the left and right front legs or front edge of the chair. Eachfigure depicts ten graphs which are the result of the processing of thesignals from the four load cells 22. The first four graphs in the upperportion of each figure comprise or specify the absolute weights sensedby each of the sensors 22 taken during 2 second intervals. The next fourgraphs show differences between the pairs of adjacent sensors asindicated on the figure. The final two graphs show the summeddifferences of the back, the front, and of the left to right sensors,and are indicated as delta right to left and delta back to front.

Referring first to FIG. 6 there is depicted the results with respect toa person in good general health without handicap arising from a chair ina very normal fashion. The weight of a person arising from the chair isinitially shifted from the back (as sensed by the change detected by theback sensors) to the front of the chair (as detected by the frontsensors) causing the rise in signal and thus the rise in weight detectedin the front sensors and a corresponding decrease in the weight detectedin the back sensors. Once the person has risen from the chair, of courseboth the front and the back sensors show a decrease and a steady statewith respect to weight. In FIG. 6 it is seen that the person is risenfrom the chair at approximately one second. Also it is to be noted thatthe differential weight shift from the front to the back indicates verylittle difference between the left to the right sides. This indicatesthat the person rose from the chair in a symmetrical manner. Thissuggests that muscle strength and coordination is balanced and that theperson rose from the chair in a normal balanced fashion relying upon theequal strength and agility with respect to muscles on both sides of thebody.

FIG. 7 includes graphs quite similar to those set forth in FIG. 6.However, the events required a longer time. Approximately two secondsare required to rise from a chair in the graphs depicted in FIG. 7.Again there is little difference between the left and right sensorsduring the event. Thus, though the person took almost twice as long, theperson arose from the chair in a very symmetrical fashion. Thisindicates the balance of the person is symmetrical although because ofthe prolonged time to rise from the chair there may be an indication ofweakness or diminished strength or some other indicator of aphysiological problems.

FIG. 8 indicates a person rising slowly from a chair and thenmomentarily falling back into the chair before completely rising. Thefact that the person fell back into the chair is indicated by thebimodal peaks in the graphs. However, in this circumstance thedifference between the left and right sensors is still comparableindicating that the person rose in a symmetric fashion. These charts mayindicate a loss of balance, a diminution or loss of muscle strength orother physiological problems, but in any event, suggest furtherdiagnosis is in order.

FIG. 9 includes graphs or tracings that indicate that the person favorsor leans to his or her left side. That is, the left side measurementsincrease while the right side measurements decrease. Otherwise, there isa shift from the back sensors to the front sensors as the person rises.The time period or term in order for the person to effect the movementis also somewhat prolonged. The pathophysiological indications fromthese charts suggest a weakness on the right side in muscle or musclecontrol or balance. Again, further testing and analysis are indicated.

Maintaining a record of such charts for a particular patient andcomparing the charts over time will enable a practitioner to understandwhether the person is maintaining a certain level of health, whether thepatient is declining in health and whether, for example, therapy isassisting the patient with respect to recovery. Further charts alongwith norms associated with certain movements will facilitate thepractitioners analysis and diagnosis.

Finger-Tip/Arm Rest ECG

Another type of data collected via the chair sensors relates toelectrical sensing, most typically, ECG sensing. Thus, two electrodes34, one mounted on the left arm 30 of the chair and one mounted in theright arm 30 of the chair, may be used to measure tile standard lead oneECG vector. The use of two electrodes 34 without a reference electrodeis made possible by using an analog design incorporating a very highcommon mode rejection. The placement of the electrodes 34 is such thatthe measurement is made by the patient holding his or her arms and handson both of the arms 30 of the chair simultaneously.

A second use of the two electrodes 34 is to provide a patient activatedswitch. Placing the fingers on the electrodes 34 provides one state ofthe switch, while removing the fingers from the electrodes 34 providesthe second state of the switch. For example, the electrodes 34 of botharms 30 may require touching or activation to initiate a sequence ofsensor operation. Consequently, initiation of the record of an ECG maynot begin until the patient properly places fingers from each hand onseparate sensors 34. Also, the patient may be required to operate theswitches 34 in a sequence or in response to an audio or video signal todiagnose sight, sound, response time or memory or attention deficit.

Alternatively, for ECG monitoring, two electrodes 34 are placed on onearm 30 of the chair and a third electrode 34 (as a ground) is placed onthe other arm 30 of the chair. The input from the two electrodes 34 onthe same arm can then be monitored to provide for the vector one ECGreading or signal.

Multiple other variations of electrode positioning on the arms 30 and/orbelts 24, 26, 28 are within the scope of the invention. For example, thesensors may be placed in the back support 16 of the chair. Suchplacement may incorporate redundancy inasmuch as multiple sensors may beprovided to sense the same feature of patient health. For example,positioning of multiple electrodes 34 on each arm for engagement byseparate digits of each hand can be utilized in combination with variousprescribed video and audio instructions (either preprogrammed orinitiated by the central station diagnostician). This may enabledetection or analysis of muscular control, memory, attention span, etc.which, in turn, provide valuable diagnostic information for detection ofdisease such as stroke, Alzheimer disease, etc.

Safety Belt Diagnostic ECG

The “safety belt” is a diagnostic element which, in a preferredembodiment, consists of two portions, a chest strap 26 which crosses thepatient's chest from the upper right to the lower left, and a lapportion 28 which crosses the patient horizontally above the abdomen fromthe right side to the left side where it meets with the chest strap 26.The straps 28, 26 are made with an elastic material allowing initialplacement of electrode pads 29 to accommodate a patient's anatomy.Electrode pods 29 are thus placed in the standard chest predefinedpositions used for the limb measurements of, LL and RL as well as thestandard chest positions used for C1, C2, C3, C4, C5, and C6 of an ECG.The leads LA and RA are obtained from the finger-tip or arm restelectrodes 34. The elasticity of the belt strap 28 insures good skincontact while the measurement is made. When the measurement is completedthe safety belt strap 28 returns into a housing 31 mounted on the sideof the chair. A full 12 lead ECG consisting of leads 1, 11, 111, AVR,AVL, AVF, V1, V2, V3, V4, V5, V6 is derived from the input electrodes29.

Alternative placement of electrodes is, as suggested above, possible.Thus, the number of electrodes, their placement, their structure andconstruction are variable depending upon the diagnostic protocol to beadapted.

Non-Invasive Blood Pressure

A cuff 33 is used to measure non-invasive blood pressure and is storedon the side of the chair. Cuff 33 is designed for easy placement on apatient's arm. The blood pressure measurement is activated remotelyafter the patient slides his arm into cuff 33. Electronics in the chaircontrol enclosure or housing 50 automatically monitors inflation anddeflation of the cuff Sensors in cuff 33 detect pressure and pressurechange. Measurement of blood pressure may be effected separately orsimultaneously with other tests described. Again, a separate datachannel coordinated with other channels may be utilized in the system.Also, the data may be gathered, processed, transmitted and analyzed inthe manner described above for load cell data. Other alternatives fordata storage and coordination with other parameters are possible againdepending upon the diagnostic protocol adopted and typically controlledfrom the central station.

Saturated Pulse Oximetry

Pulse oximetry is a means to confirm the amount of oxygen in the blood.Standard instrumentation uses a comparison of absorption of red andinfra-red light by the body tissue to determine the percentage ofoxygenated blood cells by placing a finger clip emitter/sensor 40 onpatient's finger. The chair incorporates a finger clip or socket 40located in the arm 30 of the chair The measurement will be made by thepatient placing his finger in the finger clip or socket 40. A socket 40may be provided in one or both arms 30. Again, the data may be processedas described above.

Blood Glucose Analysis

Blood glucose measurements are usually made by placing a drop of bloodon a chemically treated paper and recording the color of the paper. Thechair has an optical sensor 38 built into the arm 30 which can measurethe color of the paper. In addition, a sterilized finger prick 60 usingdisposable finger pricks is built into the arm 30. A container 41 on theside of the chair is used to store finger pricks and paper, whileanother container 62 is used for disposing the used material.Alternatively, skin sensors can be attached to the chair tononinvasively measure blood glucose levels. The chair may alsoincorporate newer blood glucose measuring devices that do not requirethe drawing of a blood sample.

Heart and Lung Sounds

An electronic stethoscope is incorporated in strap 26 or may be attachedto the side or back support 16 of the chair to assess heart and lungsounds. Alternatively, the stereoscope may be incorporated in belt orstrap 26.

Respiratory Flow Measurements

A respirometer 35 attached to the side of the chair and is used tomeasure pulmonary inspiratory and expiratory flow functions.Respirometer 35 may be incorporated in strap 26.

Skin Resistance

Skin resistance is measured by placing a high frequency signal into thefinger tip electrode 34 and measuring the associated resistance betweenthe electrodes 34.

Manual Strength Measurement

Hand grips 36 placed on one or both arms 30 with sensors are used forearly detection of neurological and neuromuscular dysfunction. The grips36 measure the active force caused by muscular contraction as well aspassive sensing of finger motion associated with tremors. Similartechnology is built into the leg support 18 rest for the determinationof leg muscle force.

Typically, referring to FIG. 3, one embodiment of a real time hand gripmonitoring device comprises a bladder 36 in the form of an ellipsoid.However, other bladder shapes may be used which are comfortable for apatient to hold or grip. The bladder 36 may be positioned andincorporated in one arm 30 or two bladders 36 may be provided, one ineach arm 30, i.e., for left hand gripping and for right hand gripping. Acomparison of signals from both the left and right hand arrangement ofbladders 36 is considered important when analyzing certain muscular andneuromuscular characteristics of a patient.

The bladder 36 is connected by a tube 70 through a check valve 72 to afluid source 74. Typically, the fluid is air, although other fluids maybe utilized. The bladder 36 further includes an internal pressure sensor76 with sending leads 77 connected thereto. The sending leads 77 connectthe sensor 76 with a data recorder 78. The data recorder 78 is connectedwith a data comparator 80.

Typically, the bladder 36 is maintained at atmospheric pressure. Whenthere is no manual pressure applied to the bladder 36, then there is nopressure differential with respect to atmospheric pressure. Squeezingthe bladder 36 increases the pressure within the bladder 36. Thispressure is sensed by the pressure sensor 76. The pressure sensor 76produces an electrical voltage proportional to the pressure applied tothe sensor which varies in time, depending upon the patient's strengthand grip. The voltage contains two elements, a direct current elementand an alternating current element. The direct current elementrepresents the absolute pressure while the alternating current elementrepresents changes in pressure associated with physiological change, forexample, information relating to muscle or hand tremors.

Thus, the signal from the sensor 76 is divided into two parallelprocessing paths. The first path is for the direct current signal.Typically, the path will have a filter that removes the AC oralternating current portion of the signal. The second path is for thealternating current portion of the signal. This path removes the directcurrent portion. In each instance, after removal of the appropriateportion of the signal, by virtue of an appropriate filter, the signal isamplified. The signals Arill then be converted into a digital format ifdesired and necessary by hardware and software in housing 50. Thedigital signals then may be transferred to a communication system asdescribed above or processed on site and then transmitted.

In practice, it is desirable to have a bladder 36 associated with boththe left hand and right hand of the patient so as to compare data withrespect to both channels for the left hand and right hand side of thepatient. The patient hand strength with respect to each hand providesadditional physiological information, for example, associated withstroke and stroke patient recovery.

In any event, the direct current signal typically will increase to asteady state value upon manual gripping. The steady state valuerepresents maximum hand strength. The length of time at that fixed valuerepresents the time during which the patient can maintain the maximumhand grip force on the bladder. Integration of that fixed valuerepresents the total energy exerted by the patient. The data istypically recorded for future comparison.

The alternating current signals are converted to an appropriatefrequency where the data frequency and amplitude are recorded.Historical comparisons can then be made for the individual patient or bycomparison to the standard formats or a standard library of information.Over time, the change in the readings on both channels can bedetermined. The differential readings with respect to left and righthand signal processing can also be determined. Thresholds can be set andan alarm can be provided which will indicate the crossing of a signalthreshold. That may be indicative of a possible abnormality of thepatient.

An alternative embodiment of the hand grip sensor includes a gripmechanism with load cell sensors in place of the bladder constructiondescribed. Other mechanical or electromechanical substitutes may beutilized to provide the AC and DC signals.

System Operation

Of course, the chair is capable of interactive use as part of a remotestation/central station system as generally described in theaforementioned U.S. Pat. No. 5,544,649. However, the present inventionincorporates not only sensor specific features associated with thechair, but also system features associated with the means and protocolfor collecting, analyzing, transmitting, and processing data. Also, theinterrelationship of the collected data is made possible for diagnosticimplication. That is, conducting and measuring multiple physicalparameters simultaneously at a remote site provides a better diagnosticoverview of a patient and the described system permits such a diagnosticoverview.

It is possible, however, to vary the function, elements and constructionof the diagnostic chair and system with the chair. For example, thenumber of load cells 22 and their geometric array may be varied in orderto enhance the data representative of factors such as weight,respiration, rate, balance, etc. Also, the chair or device may beutilized in a hospital or clinic and is not restricted to remote siteuse.

In operation, the patient is directed to sit in the chair and to followa series of steps in desired and specific sequence or simultaneously.The directions are provided through the remote monitoring audio andvideo transmission from the central station. As depicted in FIG. 4, avideo screen 51 and camera 53 are utilized in combination with thechair. As each instrument, for example, the straps 26, 28 are attachedto the patient by the patient, a signal is initiated and transmittedfrom the transmitter receiver 42 to the transmission device 44 and thenback to the central station. The electronics and logic systems in theelectronics enclosure 50 control all of the initial sensing and set upand the described processing of the various signals from the patient.Thus, data manipulation is accomplished in the software and hardware andmaintained in the chair or at the remote site as an initial first step.The essential data is then transmitted from the transmitter receiver tothe transmission device and ultimately over some network such as aswitched network to the central station. Upon completion of theexamination, the patient will rise from the chair and disconnect thechair from a power source.

The platform may be in the form of a chair as described on in the formof a bed or gurney or other subject support device. Repositioning thesensors on various platforms is viewed as within the scope of theability of a practitioner in the relevant field. The platform is alsouseful for detection of physical change, monitoring of subject wellness,emergency diagnosis, general health care management, rehabilitationmonitoring, recovery monitoring, information collection, informationdissemination, and interaction with respect to health and wellness forgeriatrics especially Examples of the utility of the device include thefollowing.

Example 1 Congestive Heart Failure (CHF) Patients

Currently CHF patients present one of the biggest challenges ofmedicine. The New England Journal of Medicine reports that heart failureaffects approximately 6 million Americans and is the leading cause ofhospitalization for adults over the age of 65. Annual expenditures forheart failure related costs are estimated as high as $38 billion,according to research conducted by the Journal of the American Collegeof Cardiologists, of which $23 billion is for hospitalizations.

Numerous studies suggest that comprehensive heart-failure-managementprograms can improve patients' quality of life, reduce hospitalreadmissions and emergency room visits and save overall costs oftreating this condition. Despite the improved results, physicians areconcerned about the low level of compliance. The lack of complianceresults in inaccurate data received from patients with the consequenceof inappropriate treatment. The present system and device permitstransmission of data such as weight, ECG, balance and coordinationinformation etc., from the patient site to the monitoring center whichwill be done automatically without the need of patient activity,audio-visual verification of medication in-take, and visual contact witha health practitioner to maintain human contact.

Example 2 Diabetes

Diabetes affects 5.9% of the U.S. population, estimated to be 15.7million Americans. Approximately half of all diabetes occurs in peopleolder than 55. Of the 65 and older population yearly 18.4% (6.8 millionpeople have diabetes). Diabetes causes many serious complications,including blindness, heart disease and kidney failure. One in fourpatients with diabetes develops foot problems which require treatment.Sixty thousand amputations are performed on people with diabetes in theU.S. each year. Complications from diabetes costs the U.S. economy $45billion each year, with an additional $47 billion attributed to indirectcosts from diabetes-related disabilities.

Diabetes requires daily self management. Education, frequent monitoringand medication adjustments in the home setting with the disclosed devicewill help patients achieve better glucose and blood pressure control,thereby preventing or slowing the progression of diabetes complications,provide psychological support achieved by audio-visual interaction witha nurse, and provide the capability of monitoring and retrieving variousvital signs (i.e., ECG, NIBP, weight) and clinical observations (i.e.,wounds, swelling, etc.) and to prevent complications such as cardiacproblems and circulatory problems leading to amputation, stroke, etc.

Example 3 Parkinson's Disease

Parkinson's disease is a progressive disorder of the central nervoussystem affecting approximately 2 out of 1,000 people, and most oftendevelops after age 50. It is one of the most common neurologicaldisorders of the elderly. Treatment begun early in the disorder can slowprogression of the disease.

The health care provider may be able to diagnose Parkinson's diseasebased on the symptoms and physical examination. However, the symptomsmay be difficult to assess, particularly in the elderly. Some of thesesymptoms are: muscle rigidity, stiffness, difficult bending arms andlegs, unstable, or slumped-over posture, loss of balance, gait changes,shuffling walk slow movements, difficulty beginning to walk, difficultyin initiating any voluntary movement, small steps followed by he need torun to maintain balance, freezing of movement when the movement isstopped, inability to resume movement, shaking and tremor, changes infacial expression.

Some of these symptoms are not specific to Parkinson and may be confusedwith other disorders that cause similar symptoms. For example, theposture changes may be similar to osteoporosis or other changesassociated with aging. Lack of facial expression may be a sign ofdepression. The tremor may not appear when the person is sitting quietlywith arms in the lap.

Untreated, the disorder progresses to total disability, oftenaccompanied by general deterioration of all brain functions. It mayresult in an early death if untreated.

Treated, the disorder impairs people in varying ways. Most peoplerespond (to some extent) to medications. The extent of symptom relief,and how long this control of symptoms lasts, is highly variable. Theside effects of medications may be severe. The device with its responsetime test and the ability to detect and measure tremors will enable theearly detection of the disease as well as the follow up of the efficacyof the medications.

The type and number of tests which can be implemented utilizing thechair or an alternative platform may be varied. AU of the testsdescribed need not be performed. Various additional tests may beincorporated into the chair using additional types of sensors. Also, thechair (device) may be automatically controlled from a remote (or near)station to automatically perform a series of tests without a nurse orprofessional guiding the subject. The system can therefore be programmedto conduct testing upon initiation by the subject of a predefinedprotocol. The test results will then be transmitted and/or recorded forlater personal review.

FIGS. 10, 11 and 12 illustrate an embodiment of the invention wherein akit is provided for use in combination with a chair 100 having a size,shape or design. More specifically, the kit is comprised of a grid 106which may be placed upon a floor or a other horizontal flat surface. Astandard chair may then positioned upon the grid 106 and, moreparticularly, upon load cells incorporated in the grid 106. Covers 108,110 for the arms of the chair 100 include various sensors and pocketsfor instrumentation for diagnostic purposes. A head rest 122 is providedand straps 126 are included for attachment thereof to the back 124 ofthe chair 100. The backside of the head rest includes various electronicgear 120 for gathering and processing and forwarding the senseddiagnostic information from a patient sitting or reclining in thestandard chair 100. Thus FIG. 10 is a photograph depicting the standardchair 100 having four legs. Chair 100 includes legs such as legs 102 and104. The legs 102, 104 are spaced one from each other in a generallyrectangular pattern. A grid assembly 106 shown in greater detail in FIG.12 is adjusted to position load sensors under each of the respectivelegs 102 and 104 as well as the legs (see FIG. 11) of the opposite sideof the chair 100.

Arm covers 108 and 110 are positioned respectively over the arms 112 and114 of the chair 100. The arm covers 108 and 110 include various sensorpads such as pad 116. The sensors, such as the sensor pad 116, aredesigned to sense aspects of diagnostic information such as heart rate,blood pressure and the like. The cover 110 includes a pocket foradditional instrumentation. Further, a storage pocket 118 may beassociated with e.g. arm cover 100. A similar assembly may be providedwith the arm cover 108.

Wireless sensors may be provided to transmit detected diagnosticinformation to a telemetry collection and transmission packet 120supported by the back side of the head rest 122 which is maintained onthe chair back 124 by a strap 126. All of the diagnostic informationgathered using the kit may then be transmitted in a manner similar tothe telemetry and transmission system previously described with respectto FIGS. 1-9.

As shown in FIG. 11, which is the opposite side of the chair 100 of FIG.10, the arm cover 108 may be hard wired through a connection 125 to thetelemetry transmission packet 120. FIG. 11 also depicts the legs 107 and109 on the opposite side of the chair 100. The grid 106 which isdesigned to support the legs of the chair 100 is shown so that it ispositioned in a manner wherein load cells are beneath each of the legsof the chair 100.

FIG. 12 depicts the in a plan view the grid 106 construction for theload cells. Four load cells 132, 134, 136 and 138 are positioned on agrid 106 comprised of plates such as plate 140. In other words, a loadcell is associated with each plate 140. The plates 140 are connected bya telescoping rod 144 in a tube 145. The rods 144 may be adjusted tospace the load cells and more particularly the plates 140 upon which theload cells 132, 134, 136 and 138 are positioned. In this manner, thegrid may be adjusted so as to position the load cells beneath the legsof any chair. Leads such as lead 150 connect each load cell to thetelemetry packet or station 120. The adjustability of the load cells aswell as the portability of the other component portions of the kitenable the utilization of the diagnostic techniques described withrespect to FIGS. 1-9 in combination with any seating arrangement orchair The cost savings and portability of the system is thussignificantly enhanced.

While there has been set forth various embodiments of the invention, itis understood that the invention will be limited only by the followingclaims and the equivalents thereof.

What is claimed is:
 1. A medical examination diagnostic device in theform of a kit for a chair comprising: a horizontal chair seat member foraccommodation of a seated patient on a chair; at least four chair seatsupport members located respectively at the corners of a quadrilateralsupport for said seat member, said seat member having a front and aback, two of said support members aligned with the back and two of saidsupport members aligned with the front edge; a frame connecting saidsupport members by adjustable links; an independent load sensor devicelocated under each of said seat support members, each said load sensordevice configured for detecting the load independently on each of saidload sensor device to provide a set of four independent data signals formedical diagnosis; a data collection device for collecting saidindependent data signals; a processor that measures and records thecollected signals as a function of time corresponding to a weightdistribution of a patient sitting on the horizontal chair seat member,said processor configured to provide an indication of each one of thedata signals as a change characterized by a temporally sequentialrelationship among said four independent recorded data signals whereinsaid indication is a medically diagnostic indicator of a physiologicparameter; and wherein each said load cell is mounted on a plate, saidplates being connected said links to form said quadrilateral grid with aload cell mounted at each corner of said grid, the distance between eachplate being adjustable, each load cell being independently connected tosaid processor.
 2. The chair kit of claim 1 wherein said processorfurther includes means for recording said data signals.